A NUMBER ON A LIST

There’s always something ominous about the brown envelope. For many, it is the least appetising item to pop through the letterbox that isn’t a flyer for inedible pizzas; let’s just say it’s not exactly a colour-coded prelude to tidings of joy. Traditionally, the brown envelope prepared the recipient for a reminder that the payment of a utility bill was overdue, though deregulation has seen that tradition dwindle somewhat as each energy provider competes to establish its own distinctive identity; dropping the grim beige of the packaging is a deceptive trick of the trade, fooling the customer into believing the news won’t be so bad after all.

For those in receipt of benefits, however, the brown envelope retains its role as a harbinger of doom – a paper soothsayer whose imagined contents radiate fear to the point where opening said correspondence can be prolonged so the suspense becomes a sickening inversion of the excitement surrounding the announcement of an Oscar winner. Anyone who has had extended dealings with the DWP (or, for that matter, its predecessor, the DHSS) will be all-too aware that missives from the organisation are not necessarily in competition with a Valentine’s card from a loved one. More often than not, the letters dispatched from the DWP are dispatched to inform the recipient that the fragile safety net they’d relied upon to prevent them falling into a bottomless pit has been removed.

I recently explained to a friend in Canada how the responsibility of British society’s most vulnerable individuals is in the hands of a private company. She had naturally assumed such a delicate and important function of the state would not have been outsourced; and so she should. Take a step back for a moment and contemplate the madness of giving the power to decide the future of the sick, the poor and the desperate to a corporate entity whose duty is to its shareholders – a corporate entity that can guarantee the renewal of its profitable contract if it assesses claimants are faking it, thus bringing down the numbers for the triumphant government statisticians come election time. We should be ashamed that we’ve let this happen.

The body of 57 year-old Errol Graham was discovered in June 2018 by bailiffs; they broke down the door of his Nottingham council flat to evict him and found the emaciated mortal remains of a man weighing four and-a-half stone. He died of starvation in the world’s fifth richest nation. Maybe we’d have expected this kind of outcome for a man with a history of mental troubles and living on the breadline in Victorian Britain; but 21st century Britain? The inquest into his death found Errol Graham had been a long-term sufferer of chronic depression and had been briefly sectioned in 2015. Upon returning to his home, he apparently ignored approaches from mental health teams and his GP; his ESA (Employment and Support Allowance) and Housing Benefit were eventually stopped within a couple of months of each other in 2017, after which lived for more than six months without any financial support.

One could surmise Errol Graham spurned help when he should have actively accepted it; but putting yourself in his shoes can require a considerable leap of the imagination if his world is a world utterly alien to you. The competent, resourceful and practical person you may well be is not the person Errol Graham was, so don’t expect him to react to situations in the same way. According to information released following the inquest into his death, he was last seen in an official capacity by a visitor from Nottingham’s City Homes housing association four months before the discovery of his body. A policewoman who attended the scene reported the only food at the property were two tins of fish that were five years out of a date; the flat was without gas and electricity. Errol Graham simply withered away.

But see him not as just another unfortunate casualty of the system; that’s how the likes of the DWP will see him; instead, see him as a person. Errol Graham was 57 when he died, placing his year of birth as 1961. Picture him as a little boy, perhaps one of the children who set aside pocket-money so that the first seven-inch single they splashed out on could be ‘Israelites’ by Desmond Dekker; picture him as a teenager, inspired to kick a ball about by the first generation of British-born black footballers; picture him as a young man, invigorated by the 2-Tone movement offering hope as the economic prospects of his part of the country entered the irreversible industrial meltdown of the Thatcher era.

Then picture him plunged into confusion by the first signs of depression, reluctantly seeking medical assistance from a GP who may or may not have been sympathetic and might possibly have idly placed him on a course of medication – pills he’d have to squirrel away from his nearest and dearest for fear his condition could be revealed; picture him being referred to a psychoanalyst and undergoing clandestine therapy sessions he is too embarrassed to share with anyone; picture his shame at finding himself in such a position at a time long before mental health became a virtue-signalling T-shirt designed to fit every celebrity, a time when the sinister spectre of the old asylums continued to cast a lingering shadow over plans for ‘care in the community’, a time when male failure to cope equated with weakness.

And Errol Graham’s journey through the minefield of the benefits system will have lifted him out of the straightforward signing-on ritual that would have been familiar to those he had been at school with to the more uncertain and unpredictable end of the maze – the place where doctors and medical personnel become involved and the need to openly demonstrate one’s mental difficulties rather than hide them is a factor in whether or not one is eligible to receive assistance from the state. Errol Graham will have spent the majority of his days attempting to come across as ‘normal’, to obscure the least acceptable side of his nature from everyone comprising his daily social discourse; and then he will have been confronted by a suspicious stranger demanding he whip away the facade of normality that required an immense amount of effort to construct in public and suddenly expose his demons as though to do so was simple. It is like enduring a mental strip search. It is a horribly dehumanising and draining exercise.

This requirement to abruptly drop the persona society demands of its citizens, only to then resume it the moment one leaves ‘the assessment centre’, is no easy ask for anyone in the position Errol Graham found himself in. It is like Mike Yarwood spending his entire life in public impersonating Harold Wilson and then being forced to do a ‘and this is me’ routine before someone he has never met before, someone who is under tremendous pressure to find the ‘me’ impersonation less convincing than his Harold Wilson. But there are no instant thumbs-up or thumbs-down; there is week after excruciating week awaiting the decision of Pontius Pilate, expecting the worst to come through the post every morning. These people have the kind of life-or-death power that those who have never been at the receiving end have no real comprehension of; and if the news is bad, it can feel like the whole world is falling in on you. And if you already feel there is no hope, such news confirms it.

As Sophie Corlett from Mind commented in relation to the sad case of Errol Graham, ‘This gentleman and many people have lifelong conditions that are unlikely to change and yet they are recalled again and again for face-to-face assessments which people find very challenging.’ If the death of Errol Graham had been an isolated incident, it would still be bad; but we all know it wasn’t. Britain, this just isn’t good enough.

© The Editor

12 thoughts on “A NUMBER ON A LIST

  1. I’m not sure it’s entirely fair to ascribe so much of the ‘blame’ to one privatised element of the support system, although it must take its share. There are many other agencies, or even just the like of neighbours, who may be considered to have each played a part in his demise, often by inaction rather than action.

    These cases are so desperately sad and it is even more sad that we don’t seem to be able to develop social systems which genuinely support such vulnerable people: they will always be there, so we should be helping them. Unless or until you’ve been in the same place as those people, you can never imagine how every minute of every day feels – I’ve never been there, so it’s very challenging to put myself in Errol’s position and see the world through his eyes.

    What I can see is that the total ‘system’ (i.e. all of us, both individuals and agencies) have failed every time a case such as Errol’s occurs, always remembering that he wasn’t just a ‘case’, he was a real person with hopes, dreams and fears, just like the rest of us.

    That said, I’m not sure that I could ever design the ‘perfect system’, one which provided all the support required to the genuinely needy, whilst not becoming a lifestyle support system for the terminally parasitic. Suggestions on a postcard to the relevant minister.

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    1. I agree the decline of traditional communities has probably facilitated the situation where one troubled individual can lock himself away and die without his absence being noticed. I saw a photograph of where he lived and it seemed to be a characteristically grim tower block, and not the kind that would be situated in a desirable part of town. Unfortunately, there is a degree of ghettoisation of those with problems of various kinds that has become the norm in recent decades, especially since the whole Care in the Community project began. At the same time, as the prime ‘carer’ of the Errol Grahams of this world, I still feel the outsourcing of such delicate services by government is a mistake. I think a good deal of privatisation has been a mistake, but at the end of the day most have at least been businesses; people’s lives shouldn’t really be included in this.

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      1. But do you realise that your friendly local GP Surgery is actually a private business? It’s a stand-alone ‘partnership’, quite independent of the NHS, a ‘business’ which simply has a contract to deliver services to the NHS, based on a capitation fee plus some extras – and that’s no different from ‘privatising’ parts of the welfare system. At the end of the year, the ‘GP partners’ share out the ‘profits’ they have made by carrying out that contract at a lower cost than the amount the NHS pays them – yes, those nasty doctors are making profits out of poorly people. Should people’s lives not be included in this? Because they are and they always have been since the NHS was founded: there can be few more personally delicate services.

        Privatising aspects of any service is not intrinsically wrong, but where governments have usually got it wrong is in how the contract is structured, of which the railway franchises are another good/bad example. However, many people have forgotten, or never knew, just how dismal the old government-run British Rail actually was, it was truly dreadful – like welfare and health, the challenge is to come up with systems and services which satisfy the users, the operators and the funders, all of whom will have different priorities and pressures. Not an easy triangle to achieve but the alternative of British Rail standards is not a particularly attractive one.

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      2. I know that many of the old asylums were privately run, so I agree it’s not necessarily a recent innovation; but I do feel that the involvement of companies such as Atos has been a disastrous development for many of the vulnerable individuals concerned, of whom Errol Graham was one. For me, this particular post was primarily to tell his story as best I could and put it in a specific context. I definitely think more needs to be done on this issue. I remember when Theresa May appointed Damian Green as Work & Pensions Secretary, he made a few promising statements that suggested a break with the policies of the Cameron administration; but then…er…events got in the way somewhat. Mind you, those events more or less did for most of what Mrs May promised in the beginning.

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      3. Your post served to emphasise the problem well and Errol Graham was just one of many whose needs have been failed by the current systems. Whether any of the new politicians, bathed in the luxury of big majorities, will manage to grab hold of the issues and move to solve them remains to be seen, but for now we must all acknowledge that there is a vast gulf between what is needed and what is delivered, we just don’t know what the answer is.

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      4. “But do you realise that your friendly local GP Surgery is actually a private business? It’s a stand-alone ‘partnership’, quite independent of the NHS, a ‘business’ which simply has a contract to deliver services to the NHS, based on a capitation fee plus some extras – and that’s no different from ‘privatising’ parts of the welfare system. ”

        Hmm. But it’s not really the same, is it? The flow of income is the other way around. The doctors are not incentivised to refuse to treat patients – the opposite is the case.

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  2. A GP Practice receives a capitation fee for each patient on its list, whether it delivers any ‘service’ to those patients or not. If you accept that every ‘service’ delivered costs that practice in staff time etc, then those who share the profits from that business could have an incentive to deliver the minimum possible service to patients, thus maximising the year-end profit and their individual share of it. That’s how private enterprise works.

    The fact that most GP practices do not aggressively avoid delivering service in order to increase profits is commendable, but the fundamental economics of that business model still apply.

    Some procedures carry additional ‘bonus’ payments for the practice, so the GPs may be incentivised to focus on those treatments – the elements which qualify for such bonus payments are usually those with fashionable or political value, as interpreted at the time by their major client, the NHS. This process can cause GPs to undertake procedures which may not be the most appropriate for that patient, but which fit the current incentivised zeitgeist.

    I’m not criticising GPs or the NHS, but merely pointing out that such ‘private enterprise’ elements already play a core role in any government’s delivery of very sensitive personal services and, even in the sainted NHS, it always has done.

    There’s no party politics in this, the GP business model was first established by the post-war Labour government and has been sustained ever since by all parties, largely unchanged. It is, however, hypocritical of the Labour Party to criticise other ‘privatisations’ when it was responsible for creating perhaps the most personal and impactful of them.

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    1. “This process can cause GPs to undertake procedures which may not be the most appropriate for that patient, but which fit the current incentivised zeitgeist.”

      Exactly! But we seem to be on different wavelengths here. The privatised social welfare services have an incentive to cut ‘clients’ off from ‘service’, i.e. payments. The opposite is the case with the GPs, no? As you’ve said, the GP’s if anything are incentivised to ‘over-service’ the ‘clients’, i.e. recommend them for procedures that are not always necessary.

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      1. Not exactly – I very carefully said “procedures which may not be the most appropriate”. Over the years there have been many ‘bonus’ procedures which earn the GP money despite them not being necessary, or even appropriate, for that patient. The opposite case applies where a practice is financially penalised for ‘excess prescribing’, even if that perceived excess is in the best interests of the patient.

        So GPs can be financially incentivised both to ‘wrongly treat’ and ‘under-treat’ because that can affect the profits of their business and thus their personal share. That’s how the model works, although I don’t believe many GPs allow it to affect their conduct dramatically . . . . but it may do, that’s what cash incentives are all about.

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  3. Hmmmmmm – all I know is that from the end of the Gordon Brown dynasty onwards, disbaled people, the poor and the unemployed have been victimised by successive governments, easy targets for their mendacious approach to the citizens of Britain. I take it that you are aware the DWP admitted that 20,000 odd people had died whilst awaiting benefit claims so Errol Graham’s death has to be measured, along with a host of others, on those terms. It is a sad, thoroughly unnecessary indictment of the authoritarian nature of government that this happens. The consequences of their actions are of little matter to them.

    Funnily, I’ve just received a brown envelope, from the DVLA, it’s my car tax renewal – there emboldened upon the envelope is this little homily : – Tax it or Lose it – we can always spot an untaxed car – threatening or what? The citizen in Britain today is no more than an unwanted drain on the elites thereby confirming we are no longer governed by consent (if we ever have been) rather ruled by unaccountable forces.

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    1. But on a more promising front, signs are emerging that another ‘tax with threats’ may soon become history, as the TV License, a poll-tax with criminal sanctions whether you use the BBC services or not, seems destined to be abolished, thus eliminating one of those ‘unaccountable forces’, the unelected BBC, which has controlled/manipulated much of our national information flow for almost a century.

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      1. ” thus eliminating one of those ‘unaccountable forces’, the unelected BBC, which has controlled/manipulated much of our national information flow for almost a century.”

        Ah mate.

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